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PM3A > Skin conditions quiz > Flashcards

Skin conditions quiz Flashcards

1
Q

What is the most common form of skin cancer but least malignant?

A

basal cell carcinoma - rodent ulcer - basal cells overproliferate
Cured in >99% of cases

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2
Q

How does basal cell carcinoma arise and treat

A

in later life due to sun exposed areas. - present as shiny dome shape nodules but not fluid filled. - spider blood vessels veins
Slow growing
surgery, radiotherapy, cryotherapy (FU, imiquimod)

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3
Q

What is. squamous cell carcinoma

A

arises from keratinocytes of the squamous epithelium
Scaly red papules that ulcerate & bleed and they can arise on head, scalp, hands
Rapid growing and metastases
If caught early - surgery/radiotherapy

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4
Q

what is the most dangerous of all skin cancers and prevalence in terms of all cancers?

A

Malignant melanoma

5% of all cancers

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5
Q

Where does melanoma occur?

A

Areas of exposed skin due to sun exposure, or positive family history
men more common in head, face, hands, back
Women more common in lower leg

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6
Q

What % of melanomas arise from pre-existing moles?

A

30%

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7
Q

What is the pharmacist role in melanoma?

A

Giving. advice e.g. sun protection, avoiding sun exposure between 10-3pm
Sun hat
Sunscreen with at least SPF30
apply regularly and use a high SPF and UVA rating
- recognise melanoma etc
- do not diagnose or recommend therapy/reassurance/referral to GP

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8
Q

what is the ABCDE acronym to recognising melanoma?

american

A

A - asymmetry - one half doesn’t match
B - border - irregular, ragged, notched, blurred
C - colour - pigmentation not the same e.g. black, brown, red, white, blue, mottled appearance
D - diameter>6mm but any growth evaluate
E - elevation

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9
Q

According to the glasgow 7 point checklist for melanoma - what are the major criteria and minor?

A

MAJOR (3)–> change in: size, shape, colour

Minor–> diameter >6mm, inflammation, bleed/ooze, mild. itch/altered sensation

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10
Q

What drug is better for athletes foot than imidazoles?

A

Terbinafine

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11
Q

How would you treat localised tinea?

A

Topical broad spectrum cream - imidazoles e.g. clotrimazole, miconazole, terbinafine TDS for 1-2 weeks

Note that if it is on the SC then the skin will regenerate and shed off the fungi and resolve alone. But if deeper then it will not resolve without treatment.

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12
Q

How would you treat widespread tinea?

A 
Oral terbinafine 250mg OD 
Itraconazole 100mg OD 
1-2 months 
Not licensed in children
Oral griseofulvin for tinea capitis
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13
Q

what is tinea incognito?

A

Tinea fungal infection modified by steroid treatment

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14
Q

How is tinea spread?

A

Direct contact

pools, sharing towels

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15
Q

Most common type of eczema

A

Atopic = dermatitis

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16
Q

What is atopic eczema

A

Genetic predisposition to allergic hypersensitivity - IgE produces dry, scaly, erythematous and itchy rash that is noticeable on face, scalp, neck, inside elbows, behind knee

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17
Q

what % of children who have atopic dermatitis go on. to develop asthma and. hayfever?

A

> 50% go on to develop asthma

>75% go on to. develop allergic rhinitis(hayfever)

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18
Q

What is atopic eczema a combination of?

A

SKin barrier damage
Genetics e.g. filaggrin (predisposition)
Triggers e.g. internal inflammation, soaps, environment

All lead to overproduction of a protease, break down corneodesmosomes, break epidermal cohesion & disrupt differentiation

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19
Q

What is irritant contact eczema and what is allergic contact eczema?

A

irritant contact is damage to skin from topically applied liquids or chemicals, no allergic mechanism
Allergic contact is where the patient is allergic to an allergen and whenever they are in contact with it they get a eczematous rash e.g. Nickel

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20
Q

How to treat eczema dermatitis? / atopic eczema

A

Let skin recover
Emollients / emulsifying ointment to maintain hydration of the stratum corneum and reduce water evaporation - this avoids dryness and cracking, increases water content - without SLS e.g. E45
- topical steroids 1% HC cream to reduce inflammation ; itch in a flare
- Sedating antihistamines e.g. chlorpheniramine piriton at night to help itch
- only use aqueous cream emollient if washing off
- Avoid soap, wool fabrics, synthetics as they dry skin/irritant (soap and aq cream contains SLS which is a harsh anionic surfactant).

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21
Q

What is the. problem with sodium lauryl sulfate?

A

Itchy
Reduces stratum. corneum thickness and increases transepidermal water loss, affects stratum corneum pH and enzyme activity/NMF - stops regulation of the barrier

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22
Q

Advice for seborrhoeic eczema

A

Reduce exposure to allergens.
Keep cool, loose cotton, avoid wool
Soap free cleanser
Regular. antifungal use

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23
Q

What is systemic lupus erythematosus characterised by?

What drugs increase risk?

A

Butterfly rash on cheeks and. nose. - exacerbated by sunlight/stresses that increase skin circulation, it is autoimmune

Phenytoin, beta blockers, lithium, sulfasalazine, penicillamine

24
Q

What is psoriasis?

A

Chronic autoimmune disorder - person has a. genetic predisposition but need other triggers. It is a chronic scaling disease causing skin redness/inflammation, with raised, rough, reddened lesions with fine silvery scales
appearing on back of elbows, flexor surfaces, sometimes scalp.
Due to increased epidermal cell differentiation (10x faster) hyperproliferation of basal cells - come to surface too quickly causing the silvery plaques

25
Q

What are the triggers of psoriasis

A
  • Infection - throat and upper Resp tract infection can lower the threshold
  • Trauma e.g. surgical incisions, rubbing, burns, scratch, sunburn, picking
  • Stress, anxiety
  • Climate e.g. sunlight
  • Drugs–> Lithium, ACEi, NSAIDS, beta blockers, alcohol abuse
  • immunological assault
26
Q

What are the types of psoriasis?

A

Plaque most common 90% - scattered raised scaly patches on elbows, knees, scalp - itchy, sore, silvery

Guttate - (teardrop shape) patches all over body - common in young and may follow throat infection. can spontaneously. resolve

Flexural (inverse)- on areas of skin-to-skin contact e.g. armpits, groin, buttocks = later life

Generalised pustular = acute severe eruption of pustules, red skin and high fever - can be due to large amount of steroid creams. Not v common

pustular- chronic, on hands and feet, middle age

Psoriatic. arthritis - inflammatory joint. disease - skin change before pain

27
Q

Treatment aims in psoriasis

A

Control/management not a cure - aim to reach a point where they can tolerate symptoms and can occur every 3. months in cycles
- not itchy, painful, looks better

28
Q

Key treatments in psoriasis

A

Emollients hydrate skin/anti-proliferative
Topical CCS - inflammation. Mild for face/flexures, strong for scalp, hands, feet (betamethasone)
Calcipotriol (dovonex) - synthetic vitD3 analogue interferes with cell division and differentiation
(mildest effective treatment shortest time).

Other

  • Dithranol - good to induce remission, irritates normal skin, not widespread/face/flexures.
  • Coal tar anti-inflammatory and anti-scaling but messy
  • salicylic acid keratolytic for scalp
  • Retinoids mild to moderate affecting 10% of skin, tazarotene 0.05%
29
Q

What are comedones?
Papules?
Nodules?
cysts?

A

Blackheads (open), whiteheads (closed)
papules are pinheads - elevation of skin, no fluid 5-10mm
Nodules are bigger than 5-10mm but papule like
Cysts are fluid fulled cavities

30
Q

Common places of acne

A

Face, shoulders, trunk, arms, legs

31
Q

How is acne formed?

A

When hair follicles & sebaceous gland become obstructed with sebum/dead keratinocytes. (usually due to increased androgens producing. more sebum and thys hyperproliferation of keratinocytes). Can become infected with normal skin anaerobe p.acnes leading to inflammation. Lipases from p.acnes metabolise triglycerides into FFA which irritate the follicular wall and then result in inflammation in the follicle, causing pustules/pus.

When the inflamed follicles rupture, it causes nodules & cysts

32
Q

Treatment of acne

A

main aim to reduce sebum production, comedone formation, inflammation & infection.
Cleanse affected areas daily but no need for extra washing, scrubbing,or antibacterial soaps (no added benefit as within the gland).
Managing expectations will not work straight away
usually improves with age
Not using occlusive make up
No need for changes in diet
Mild-moderate topical
Moderate-severe systemic abs

33
Q

How does benzoyl. peroxide work for acne?

A

Peroxide is metabolised to benzoic acid and oxygen free radicals, benzoic acid reduces pH and the O2 free radicals are bactericidal and break down keratin so are comedolytic.

34
Q

What is an alternative to benzoyl peroxide if irritation / sensitive / face?

A

Azelaic acid - anti-microbial and anti-comedomal but less likely to cause irritation

35
Q

What is rosacea?

A

Inflammatory skin disease affecting middle third of the face, occurs in adults age 30-60 and fair skin, no blackheads/whiteheads.

  • redness over face/nose that blush, dilation of blood vessels
  • cyclical
36
Q

Triggers/causes of rosacea

A 
Unknown - genetic and environment
Blush easily
Emotion, stress, embarassment
changes in weather. - wind, humid, sun 
H.pylori 
vasodilators, CCS
spicy food, coffee, alcohol.
37
Q

Treatment of rosacea

A

Topical metronidazole (little effect on vascular component) - mainly just reduce inflammatory papules

Topical azelaic acid for redness
oral tetracycline

38
Q

Advice for rosacea

A

Sunscreen spf>30
Protect face in winter e.g. scarf
Avoid skin irritants and products containing alcohol
when using a moisturiser with topical meds - apply the moisturiser after the medicine has dried
Use products that are ‘non-comedogenic’ so will not clog pores
Avoid alcohol
Don’t touch/rub area

39
Q

Ideal characteristics for a wound dressing

A 
Maintain moist environment 
Manage excess exudate 
allow oxygenation 
provide a barrier to microorganisms
maintain a warm environment
not shed particles/fibres 
eliminate odour
cost effective
acceptable for the patient
non irritating
40
Q

If someone has very severe psoriasis?

A

Oral - retinoids

  • methotrexate
  • ciclosporin
  • mABs /biologics
41
Q

What is the pharmacists role in psoriasis?

A

Recognising it
Reassurance and support, telling them it is recurring and many will be aware.
Mild - reassurance and emollient
If otherwise - refer to GP

42
Q

What are acne triggers?

A 
Hormones 
puberty
pregnancy
make up (occlusive) 
excessive humidity/sweating 
stress
drugs e.g. steroids - under steroidal control
43
Q

Side effects of isotretinoin

A 
Sun sensitivity /photophobia
dry skin 
teratogenicity 
CV problems as increases lipids 
Depression
44
Q

What can be used to treat scabies?

A

Permethrin

ivermectin

45
Q

What is the characteristic symptom of impetigo?

A

Honey coloured crusts on face

46
Q

When providing benzoyl peroxide what should you advise to patient?

A

Can cause some irritation but will subside

may not work straight away and keep using to work - managing expectations

Can stain clothes.

Will start at low dose and increase up by concentrations
2.5, 5, 10%

47
Q

WHAT ARE SOME drugs that can cause phototoxicity

A 
TCAs
retinoids
tetracyclines
methotrexate
trimethoprim / sulfonamides
furosemide 
thiazide diuretics 
quinolones 
Perfumes
coal tar
48
Q

Does phototoxicity require prior sun exposure?

A

No

49
Q

If you have a wound that has healed why is it not as strong as the original skin?

A

Collagen is not as strong because initially it gets laid down quickly and does not have time to organise.

50
Q

What type of allergy is photoallergy?

A

Type 4 inappropriate T cell activation. Need prior exposure

51
Q

What is a sloughy wound?

A

Yellow. cellular debris, fibrin, exudate, bacteria

52
Q

What is a granulating wound?

A

Vascularised pink/red wound

53
Q

What is an epithelialising wound?

A

Pink wound bed, cells migrating from wound edge to start re-epithelialisation

54
Q

What is the typical acne scar called?

A

Atrophic scar -sunken, pitted

55
Q

What can alginate dressings be used for?

A

Wet or cavity wounds

Calcium or sodium salts - absorbent

PM3A (17 decks)

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